Title

低位直腸癌病人行肛門括約肌保留手術後生活品質之探討

Translated Titles

Quality of life after surgery of sphincter preservation for low rectal cancer

DOI

10.6342/NTU201700996

Authors

平泰瑋

Key Words

低位直腸癌 ; 肛門括約肌保留手術 ; 腹部會陰切除術 ; 生活品質 ; 家庭功能 ; low rectal cancer ; sphincter-preserving surgery ; abdominoperineal resection ; quality of life ; family function

PublicationName

臺灣大學護理學研究所學位論文

Volume or Term/Year and Month of Publication

2017年

Academic Degree Category

碩士

Advisor

戴玉慈

Content Language

繁體中文

Chinese Abstract

由於基因遺傳及飲食西化等因素,近年來罹患結腸直腸癌的病人日漸增加,其中腫瘤生長部位又以低位腸道之癌症(乙狀結腸與直腸交接處以及直腸部位)所佔比例最多。尤其針對低位直腸癌病人,除了需要面對罹癌本身的心理衝擊外,尚需面對因手術後所造成排便、排尿或性功能等之障礙而導致生活上的許多不便及衝擊,使得這類病人的生活品質受到嚴重影響。為降低手術後的衝擊,手術式經歷重大變化,從腹部會陰切除術切除直腸及肛門,留置永久性造口,改成肛門括約肌保留手術,但兩類手術對病人短期和長期的生活品質影響為何,未有定論。本研究目的是探討罹患低位直腸癌行肛門括約肌保留手術病人:(一)術後出院六個月內及術後出院日滿六個月以上之腸道功能障礙及健康相關生活品質之差異;(二)手術後腸道功能障礙嚴重度及家庭功能與整體生活品質之相關性;(三)與行腹部會陰切除術病人整體生活品質之比較。 本研究採立意取樣,以橫斷式及描述性相關性設計,使用結構式問卷於北部某醫學中心之門診進行收案,本研究共收案低位直腸癌行肛門括約肌保留手術之病人78位及腹部會陰切除術之病人10位。研究工具包含:個案人口學基本資料、EORTC QLQ-C30及EORTC QLQ-CR29、直腸癌低前位切除綜合症評分量表(LARS Score)及家庭關懷度指數(Family APGAR Index)。研究結果以T test、one-way ANOVA及複迴歸等統計方式進行資料分析。 本研究結果發現低位直腸癌行肛門括約肌保留手術之病人其術後腸道功能障礙嚴重度及家庭功能可預測整體生活品質。病人之家庭功能越好者,整體生活品質也越好;而病人術後腸道功能障礙越嚴重者,其整體生活品質則越差。另外,本研究也發現,比較術後出院日滿六個月以上之行肛門括約肌保留手術及行腹部會陰切除術的病人之整體生活品質,結果有顯著差異,行肛門括約肌保留手術之病人整體生活品質較差。但肛門括約肌保留手術者進一步依術式差異分為低前位切除及全直腸繫膜切除兩組,比較其生活品質,結果發現低位直腸癌行全直腸繫膜切除術者之整體生活品質皆比行低前位切除術者及行腹部會陰切除術者差,而行低前位切除術者與行腹部會陰切除者間無顯著差異。 根據本研究結果得到低位直腸癌經歷有或無肛門括約肌保留術式後生活品質差異,及術後腸道功能障礙嚴重度以及家庭功能程度與病人之生活品質關係的知識,可協助醫療專業人員視不同腸道功能障礙嚴重度及家庭功能之病人,計劃給予不一樣的介入及幫助,以及考量病人之家庭,並強化其功能,協助病人及家屬適應抗癌生活,提升整體生活品質。

English Abstract

Owing to hereditary factors and Westernized cuisine, the number of patients suffer from colorectal cancer has increased in recent years. Most tumors develop in the lower regions of the intestinal tract (in the junction between the sigmoid colon and the rectum and in the rectum). It is especially difficult for these patients with low rectal cancer to return to the same quality of life they had previously. Besides the psychological impact, the patients undergo the surgery may leave them with dysfunction of defecation, urination and sexual function. These problems cause them inconvenience and impact their quality of live significantly. To reduce this impact, the type of surgery has changed greatly. Abdominoperineal resection (APR) would leave a permanent stoma. This is changed to sphincter-preserving surgery (SPS) that would preserve sphincters. However, the short-term and the long-term impact of the above two surgeries on the patient’s quality of life have not come to a conclusion yet. The purposes of this study are 1) compare the bowel dysfunction and health-related quality of life between patients who have undergone SPS less than six months and more than six months; 2) examine the influence of the degree of bowel dysfunction after SPS and family function on the overall quality of life; and 3) compare the overall quality of life between patients who have undergone SPS and APR. This study adopts purposive sampling and uses cross-sectional, descriptive and correlational study design examining cases from outpatients at a Medical Center in Northern Taiwan with data collection by using structured questionnaires. Participants are patients with lower rectal cancer. 78 of them had undergone sphincter-preserving surgery, and 10 of them had undergone abdominoperineal resection. The measurement tools include the basic case demographic information, EORTC QLQ-C30 and EORTC QLQ-CR29, the low anterior resection syndrome score (LARS score), and the family APGAR index. The results were analyzed by t-tests, one-way analysis of variance (ANOVA), multiple regression, and other methods. The results show that the overall quality of life of patients who have undergone sphincter-preserving surgery can be predicated by family function and the degree of bowel dysfunction after surgery. The patient’s quality of life increased along with the better family function, and decreased along with the higher degree of bowel dysfunction. Moreover, this study also found a significant difference between the quality of life in patients who have undergone SPS and APR over six months. The patients who have undergone SPS have the lower quality of life. We further divided patients who underwent SPS into two groups according to their type of surgery: total mesorectal excision (TME) and low anterior resection (LAR) and analyze the difference between TME, LAR, and abdominoperineal resection (APR). The results show that the overall quality of life of patients who have undergone TME have the lower quality of life than that of LAR and APR. There is no significant difference between LAR and APR. The results of this study provide insight into the quality of life of patients who have undergone sphincter-preserving surgery or not for lower rectal cancer, as well as drawing a relationship between the quality of life, the degree of bowel dysfunction and family function. It would help healthcare professionals to plan the unique interventions according to the different degree of bowel dysfunction and family function, and strengthen family function to help patients and their family to adapt to their new way of life and raise their quality of life.

Topic Category 醫藥衛生 > 社會醫學
醫學院 > 護理學研究所
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